Hepatitis C still here

Outbreak affects current, former Manor Care residents

December 28, 2013

The news about its existence may have gone quiet for a short time, but the outbreak of hepatitis C is still being investigated at Manor Care Health Services in Minot.

In a news release issued on Dec. 27, the North Dakota Department of Health announced preliminary findings from the outbreak of the hepatitis C investigation. "The goal of this investigation was to identify modes of transmission or risk factors associated with hepatitis C in this population and stop ongoing transmission," said Tracy Miller, state epidemiologist for the North Dakota Department of Health. "At this time we still do not fully understand how transmission occurred."

Currently, all of the cases involve current or former residents at Manor Care Health Services in Minot. An epidemiologic analysis has been conducted comparing exposures among those residents infected with hepatitis C to exposures among those who were not infected. This analysis provided preliminary statistical information suggesting that having hepatitis C may be associated with the receipt of some procedures. The procedures include podiatry and phlebotomy (blood draw) services through contractual agreements with Trinity Health, as well as nail care services provided by Manor Care.

Article Photos

Jill Hambek/MDNManor Care Health Services in Minot, shown in this exterior shot, has seen an outbreak of hepatitis C and has been under investigation. It’s suggested that those who have been infected with hepatitis C may be associated with receiving certain healthcare procedures at Manor Care. The general population is not considered at an increased risk of infection.

"Through observations and interviews, we further investigated these areas looking for possible breaches in infection control procedures that would explain the transmission of hepatitis C," said Miller. "However, we did not observe any obvious breaches that would explain transmission."

The data analysis did not show any association with having hepatitis C and receiving any other health care services in the community. The general population is not considered at an increased risk of infection.

"Even though we have not identified the exact method hepatitis C was transmitted in this outbreak, the healthcare providers have worked proactively with us to review and reinforce policies and procedures to strengthen infection control protocols," Miller said. Throughout this investigation, all of the healthcare partners that the North Dakota Department of Health have been involved with have been engaged and cooperative, she continued. "Everyone's goal is to protect patients and provide the highest quality health care possible."

The North Dakota Department of Health plans on bringing in a specialist to help review infection control policies and procedures in both Manor Care and Trinity. No exact method of transmission is ever identified in about one-third of all hepatitis C outbreak investigations. In these outbreaks where an exact method of transmission has not been identified, however, placing an emphasis on strict infection control procedures has proven effective in stopping the spread of infection.

The outbreak of hepatitis C will continue to be monitored by the North Dakota Department of Health. Targeted testing in healthcare facilities and in the community will continue to be conducted. Anyone for whom testing is recommended will be notified by the Department of Health.

This investigation was conducted with assistance from the Centers for Disease Control and Prevention, as well as other state and local agencies. Currently, 44 cases of hepatitis C have been identified as part of the outbreak. Ages for cases range from 38 to 100, with the median age being 84. All of the cases have a complex health care history, including inpatient care, outpatient care and long-term care.

Hepatitis C is a viral infection that can cause serious liver disease. People with hepatitis C should work with their healthcare provider on a care plan for their infection. Hepatitis C is mainly transmitted through blood-to-blood contact. It is not spread by sharing eating utensils, hugging, kissing, holding hands, coughing or sneezing, and it is not spread through food or water.

People who have questions about either this outbreak or about hepatitis C in general may call the North Dakota Department of Health's public health hotline toll-free at 1-866-207-2880. The hotline is open from 8 a.m. to 5 p.m. on weekdays. Information is also available on the NDDoH website at (www.ndhealth.gov), Facebook and on Twitter with the hashtag #ndhepc.